Your mom just made an appointment for your first gynecologic exam and you're feeling:
Totally panicked. You start praying for an avalanche, four flat tires on the car, anything to avoid that appointment.
Pretty calm. You don't really mind going to the doctor that much, and if your friends can handle it, so can you.
Confused. You don't feel sick at all, and you just had some vaccinations for school and a physical for sports. Why waste time going to a doctor when you're OK?
These are just some of the feelings that girls may have before their first gynecologic (or "gyn") exam, and it's not surprising. You might be asking yourself "Why me? Why now?" The answer is that you're older and have gone through puberty, so you need to have a physical exam appropriate for a young woman. That's where breast and pelvic exams come in.
Why You Need These Exams
The American College of Obstetricians and Gynecologists recommends that a girl make her first visit to a gynecologist when she is between the ages of 13 and 15. Not all girls will need a pelvic exam during this initial visit, though. Many gynecologists will just do a regular health exam and talk to the girl about her development.
Yearly gyn visits are important for a number of reasons, including:
as a routine check. You'll want to be sure you're developing normally.
to prevent pregnancy or infection. If you have ever had sex, you are probably going to need a pelvic exam. Girls should have a pelvic exam before having sex to discuss methods of birth control and preventing sexually transmitted diseases (STDs).
to deal with a problem. There may be a number of concerns that lead to a pelvic exam. For example, if you have problems with your periods, missed periods, pain, signs of infection, and worries about development, it's a good idea to see a doctor.
Choosing the Right Doctor
If you're going to be involved in deciding who you'll see for your pelvic exam, you have a few choices. Many family doctors and pediatricians perform pelvic and breast exams and advise teens on birth control and STD prevention. So you may be able to see a doctor you already know and feel comfortable with for your first pelvic exam.
Also, a number of different kinds of doctors and nurses have special training in women's reproductive health:
Gynecologists are doctors who have been specially trained in women's health issues. Gynecologists are one of the doctors who can prescribe birth control and teach patients how to use it.
Adolescent medicine doctors have been trained in the health and management of teen issues. They are familiar with the concerns most young women have about their reproductive systems and can advise them on birth control and STD prevention.
Nurse practitioners have had advanced training that allows them to give gynecological exams and pay special attention to women's reproductive health.
Whether you want to see a male or female health care professional is up to you. Some women say that they prefer being examined by a female doctor or nurse because it puts them more at ease and they feel like they can talk more openly about women's health problems and sexuality issues. Other women feel comfortable being examined by a male doctor or nurse. If the doctor or nurse is male, he will usually have a female assistant in the room with him during all parts of the exam.
It's best to involve your parents in your health care. If you want to go to a doctor's office for your exam, you may need to involve an adult for insurance purposes (it may be expensive otherwise).
If for some reason you can't involve your parents, you can take advantage of health clinics like Planned Parenthood or your local teen clinic. These clinics have fully trained staff who often can care for you at a lower cost and respect your need for confidentiality. Each state has different guidelines on which medical issues teens can get confidential care for. Your doctor should be able to explain these issues to you.
The most important thing is that you feel comfortable with the person who is examining you. You want to be able to talk with him or her about important personal health and relationship issues, including birth control.
What Happens When You Go for Your Pelvic Exam
You don't need to do anything special before going for your exam. When you make the appointment, try to schedule the exam for a time when you won't have your period. For many young women, that can be hard to predict, though — lots of girls have irregular periods at first. Ask the doctor's office or clinic when you make the appointment what you should do if you get your period. Some doctors say it's OK to come for an exam if your period is just beginning or just ending and it's very light, but everyone has a different policy.
When you arrive for your appointment, you may be asked to fill out some forms while you wait. These forms ask questions about any illnesses or conditions you have, your health habits (like whether you drink or smoke), any family illnesses that you know of, and your history regarding sexual activity, pregnancy, and birth control. You might also be asked for the date of your last period (or a doctor or nurse will ask during your exam).
When you first go into the exam room, a nurse or medical assistant will do a few things that your doctor has probably done a million times before, such as recording your weight and taking your blood pressure. You'll then be left alone to change out of your clothes. It may feel weird taking off even your underwear because you may not have had to undress completely for a medical exam before. The nurse or medical assistant will leave you a paper sheet or gown — or maybe both — to cover you. If you're cold, most doctors and nurses won't mind if you keep your socks on.
After a few minutes, the doctor (or nurse practitioner, if that is who you choose to see) will knock on the door to make sure you're in your gown. If you're ready, he or she will come in and start the exam. The doctor may start by going over anything you wrote down on your forms, or you may talk about these things later.
If this is your first gynecologic exam, let the doctor know. That way, he or she will know to go slowly and explain everything that's going on. Now is also the time to ask about birth control or sexuality if you need to. Some doctors like to discuss these things before the exam, and some like to do it after. Your aim is to make sure you get your questions answered.
The Breast Exam
During the physical part of the gynecologic exam, you'll be asked to lie on your back on the table. You'll have the paper sheet or gown covering you, and the doctor will only uncover the parts of your body being examined.
The doctor will give you a breast exam by lightly pressing on different parts of your breasts. After finishing, he or she may show you how to examine your own breasts. This helps you become familiar with how your breasts feel so you know which lumps are normal and which may be the result of a change.
The Pelvic Exam
During the pelvic part of the exam, the doctor or nurse practitioner will ask you to move down so your behind is at the end of the table. You'll bend your knees and rest your feet in two stirrups, which are metal triangular loops that stick out from the end of the table. These might look a little scary, but they're just there to rest your feet in and keep you more comfortable. The doctor will ask you to relax your knees out to the sides as far as they will go. It might feel a little funny to be lying with your legs opened like this, but everyone feels that way at first.
The doctor will put on gloves and examine the outside of your vagina to make sure that there are no sores or swelling and that everything looks OK on the outside.
Next, the doctor will want to look at the inside of your vagina and will do so with the help of a speculum (pronounced: speh-kyuh-lum). A speculum is a thin piece of plastic or metal with a hinged piece on one end that allows it to open and close. The doctor or nurse will warm the speculum with water (some offices keep the speculum warmed in a drawer with a heating pad). The doctor or nurse will then slide the speculum into your vagina. Usually the doctor will tell you when he or she is about to place the speculum inside you so it doesn't come as a surprise.
Once the speculum is in the vagina, it can be opened to allow the doctor to see inside. Putting in and opening the speculum should not be painful, although some women say that it can cause a bit of pressure and discomfort. Naturally, if this is your first exam, you might feel a little tense. Because the vagina is surrounded by muscles that can contract or relax, the exam can be more comfortable if you try to stay calm and relax the muscles in that area.
If you feel like you're tensing up the muscles in your vagina, try breathing deeply or doing some breathing exercises to help you stay relaxed. Sometimes humming your favorite song or making small talk can distract you and allow you to feel more relaxed.
After the speculum is in place, the doctor will shine a light inside the vagina to look for anything unusual, like redness, swelling, discharge, or sores. He or she may then do a Pap smear, which involves touching the cervix to pick up cells from that area.
The cervix is the opening to the uterus, and it's located at the very top of the vagina. The Pap smear should not hurt, but it might be uncomfortable, especially if this is your first pelvic exam. The good news is this part of the exam is over quickly.
The cells that have been collected are sent to a laboratory where they are studied for any abnormal cells, which might indicate infection or warning signs of cervical cancer. (Like breast cancer, cervical cancer is very unusual in teen girls.)
If you have had sex, the doctor or nurse practitioner may test for STDs. He or she will swab the inside of the cervix with what looks like a cotton swab. The speculum is then slid out of the vagina. As with the Pap smear, the sample is sent out to a laboratory where it is tested for various STDs.
Talk to your doctor or a nurse about how you want to be contacted with results, and what they should do if they are unable to reach you. Again, doctors and nurses will do their best to maintain confidentiality, but they need to be able to reach you.
Because the ovaries and uterus are so far inside a girl's body that they can't be seen at all, even with the speculum, the doctor will need to feel them to be sure they're healthy. While your feet are still in the stirrups, and after the speculum is removed from the vagina, the doctor will put lubricant on two fingers (while still wearing the gloves) and slide them inside your vagina. Using the other hand, he or she will press on the outside of your lower abdomen (the area between your vagina and your stomach). With two hands, one on the outside and one on the inside, the doctor can make sure that the ovaries and uterus are the right size and free of cysts or other growths.
During this part of the exam, you may feel a little pressure or discomfort. Again, it's important to relax your muscles and take slow, deep breaths if you feel nervous.
At this point, the physical part of the exam is usually over. Your own doctor may do the exam in a different order, but it will probably include all these steps.
After the Exam
Although reading this article may make it seem long, the entire pelvic exam (the parts involving your vagina, cervix, uterus, and ovaries) really only takes about 3 to 5 minutes.
Afterward, you'll be left alone to get dressed. Some women say that they bleed a tiny bit from the Pap smear after the exam, so they like to put a pantiliner in their underwear as they get dressed. If you bleed a tiny bit, it's no big deal — it's nothing like a period and it won't last.
If you haven't discussed your questions before the exam, now's the time. Don't be afraid of questions that sound stupid or silly — no question about your body is stupid, and this is the best time to get answers.
The Pap smear is almost always normal in teen girls. But if for any reason the doctor or nurse practitioner needs to see you again, the office or clinic will let you know. Unless you notice any health problems, you won't need to go for an exam for another 6 months to a year.
It's very important to go for pelvic exams on a yearly basis — even when you're feeling good — because they help detect any problems early on. If you don't want to return for another exam because you didn't like the doctor or nurse practitioner, look into finding a new doctor or clinic.
And if the physical discomfort of the exam left you not wanting another, remember that each time it gets easier and easier to relax. Naturally, no one loves getting an exam, but having a doctor or nurse practitioner you trust can really help.